Effects of Remote Ischemic Preconditioning and Postconditioning on Lung Injury During Cardiopulmonary Bypass

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01144585
Recruitment Status : Completed
First Posted : June 15, 2010
Last Update Posted : June 4, 2014
Information provided by:
Seoul National University Hospital

Brief Summary:
Remote Ischemic Preconditioning(RIPC) and remote ischemic postconditioning(RIPoC) seems to have a protective effect during ischemic period. Using cardiopulmonary bypass(CPB) during open heart surgery reduces pulmonary blood flow and may cause ischemic damage to lung tissue. The investigators anticipate that RIPC and RIPoC may reduce lung injury after CPB.

Condition or disease Intervention/treatment Phase
Acute Lung Injury Procedure: remote ischemic preconditioning and postconditioning Procedure: Control Not Applicable

Detailed Description:

Cardiopulmonary bypass(CPB) can cause lung function deterioration through various mechanisms. Lung parenchymal tissue ischemia resulted by pulmonary atelectasis and decreased bronchial circulation during CPB is one of the reasons. There were few studies reported that RIPC and RIPoCcan benefit lung function of children or infant after CPB, but studies about adults are still lacking.


The purpose of this study is to evaluate effect of RIPC and RIPoC on the lung function after CPB.


Patients will randomly allocated either in study group or control group. Study group will receive RIPC and RIPoC maneuver before and after CPB. Control group will have same automated cuff around their arm but it will not activated. Care givers will be blinded whether the automated cuff is on or not.

We will compare pulmonary parameters (PaO2/FiO2, dynamic and static compliances, Intrapulmonary shunts, etc.) between study group and control group, and check levels of plasma cytokines(IL-4, IL-8, IL-10, TNF-alpha) till 24hr after the operation.

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 76 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Care Provider)
Primary Purpose: Prevention
Official Title: Effects of Remote Ischemic Preconditioning and Postconditioning on Lung Ischemic-reperfusion Injury During Cardiopulmonary Bypass - Substudy of NCT00997217
Study Start Date : May 2010
Actual Primary Completion Date : November 2010
Actual Study Completion Date : November 2010

Arm Intervention/treatment
Experimental: RIPC
those who receive RIPC and RIPoC before and after CPB
Procedure: remote ischemic preconditioning and postconditioning
RIPC is done before the use of CPB. It consists of 4 cycles of 5 minutes inflation of pneumatic cuff to 200 mmHg and deflation for 5 minutes. RIPoC is exactly same procedure done "after" CPB.

Placebo Comparator: Control
this group have same pneumatic cuff around their arm, but it is not inflated.
Procedure: Control
This group has same pneumatic cuff during the surgery, but it is not inflated during the surgery

Primary Outcome Measures :
  1. arterial partial pressure of oxygen divided by fraction of inspired oxygen [ Time Frame: within 24hr after the surgery ]
    follow up PaO2/FiO2 during operation and after the opreation for 24 hours

Secondary Outcome Measures :
  1. plasma cytokines [ Time Frame: within 24hr after the surgery ]
    follow up plasma IL-6, IL-8, IL-10, TNF-alpha levels during the surgery and within 24hr after the surgery

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Ages Eligible for Study:   20 Years to 80 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • those who aged 18-80 years old and planned to undergo elective open heart surgery using cardiopulmonary bypass

Exclusion Criteria:

  • emergent operation
  • preoperative use of inotropics or mechanical assist device,
  • left ventricular ejection fraction less than 30%,
  • severe liver, renal disease,
  • recent myocardial infarction (within 7 days),
  • recent systemic infection or sepsis (within 7 days)
  • peripheral vascular disease affecting upper limbs
  • amputation of the upper limbs
  • major combined operation such as aortic surgery or carotid endarterectomy
  • descending thoracic aortic surgery
  • rare surgeries; cardiac transplantation, correction of complicated congenital anomalies, pulmonary thromboembolectomy, etc
  • significantly decreased pulmonary function before the planned surgery (e.g. using ventilator, oxygen therapy, tachypnea, orthopnea, active lung lesion on chest X-ray, FEV1/FVC less than 50% of predicted level, PaO2 less than 80 mmHg)
  • intracardiac shunt
  • severe pulmonary artery hypertension
  • systemic or local steroid therapy

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01144585

Korea, Republic of
Seoul National University Hospital
Seoul, Korea, Republic of
Sponsors and Collaborators
Seoul National University Hospital
Study Director: YunSeok Jeon, MD Seoul National University Hospital

Responsible Party: Seoul National University Hospital Identifier: NCT01144585     History of Changes
Other Study ID Numbers: H-1001-016-306
First Posted: June 15, 2010    Key Record Dates
Last Update Posted: June 4, 2014
Last Verified: June 2014

Keywords provided by Seoul National University Hospital:
lung protection
ischemic reperfusion injury
cardiopulmonary bypass

Additional relevant MeSH terms:
Wounds and Injuries
Lung Injury
Reperfusion Injury
Acute Lung Injury
Respiratory Distress Syndrome, Adult
Lung Diseases
Respiratory Tract Diseases
Thoracic Injuries
Vascular Diseases
Cardiovascular Diseases
Postoperative Complications
Pathologic Processes
Respiration Disorders